Review History
Perception, knowledge, and attitude of medical doctors in Saudi Arabia about the role of physiotherapists in vestibular rehabilitation: a cross-sectional survey

Thanks for attending to my requests. I'm now happy to recommend this paper accepted for publication in PeerJ.

I thank the authors for their attendance to most of the previous requests from the reviewers and I. There are just some minor typographical errors that require correction prior to my recommendation that this paper be accepted for publication in PeerJ. These corrections refer to the page numbers in the track changes word manuscript. These include:

Page 2: my request for you to change data presented with 2 decimal places to one decimal place was only with respect to the percentages of your sample who responded in a particular way, not with respect to the chi-square statistic. Therefore, please leave this as “482.476” as such detail can be useful for individuals performing meta analyses. This correction also needs to be applied to all of the other chi-square, odds ratio and confidence interval statistics throughout the manuscript, such as on page 10.

Page six: this revised section needs some of the capitalisation altered and should read as “If the medical doctors answered that they did not see the patient with vestibular patients, the questionnaire was terminated after collecting demographic information.”

Page 17: I suggest some small typographical changes to the sentence in the revised paragraph. Specifically, the second sentence might read better as “The Saudi Arabian doctors may benefit not only from further education into benefits of physical therapy for their patients, but also behaviour change theories and approaches, so that they can better promote the physical therapy services to their patients.

Page 17: the following section in the limitations may also require typographical changes. Specifically, I request the following change “These low response rates and relative equivalence in the medical doctors who are involved or not involved with patients with vestibular disorders, may affect the generalisation of these results to the population of Saudi Arabian doctors.

I would like to thank the authors for their hard work in attending to many of the concerns of the three reviewers of the initial submission of the manuscript. While only the first reviewer has provided feedback on this resubmission, I feel that there are still a number of concerns raised by the second and third reviewer that still need further amendments prior to this manuscript being more seriously considered for publication in PeerJ. These include the following comments (with the line numbers relating to the PDF version of the resubmission):

Line 151 and multiple other sentences, potentially also the tables: I disagree with the way one of the reviewers suggested you write these results and percentages. I would suggest you follow this template for the data presented on line 151 and use this throughout the document. The data should be written as (n-187, 49.2%). As suggested here, I also don’t believe there is any benefit from adding in two decimal places, so please report these values in the text as well as in your tables to one decimal place only.

Line 184 – 186: this sentence needs to be rewritten to some extent. Perhaps something like “The remainder of the 21 responses from the medical doctors stated that a lack of confidence (add n and percent values here), lack of experience (add n and percent values here) and insufficient knowledge among physiotherapists (add n and percent values here) were the primary barriers.

Line 252 – 254: you have already stated this on line 246 – 248. Therefore, this sentence can be removed from here as it is redundant.
Line 258 – 261: I suggest this sentence be removed as it doesn’t add anything to the manuscript, rather it reads like a somewhat superficial part of the introduction.

Line 265 – 266: this should read as “A number of research studies have examined the potential for modern physical therapy ……”.
Line 273 – 288: I suggest this sentence be removed as it doesn’t add anything to the manuscript, rather it reads like a somewhat superficial part of the introduction.

Line 356-359: I think you need to expand this a little bit in regards to the limitations of your study. The first concerns the response rate of 30%. The second reflects the fact that somewhere around half of your sample where not necessarily highly active with patients with vestibular disorders, which further reduced the size of your sample. In terms of the generalisability of these results, how similar were the demographic and professional characteristics of your participants to those of the wider Saudi Arabian population of these health professionals?

Overall discussion: I think there also needs to be a bit more presented in the discussion regarding what the primary barriers are that underlie the relatively low prevalence of physiotherapy referrals by medical practitioners for patients with vestibular disorders. For example, does it primarily reflect a lack of knowledge and respect of physiotherapists by medical practitioners in this country, a lack of knowledge of the medical practitioners on the benefits of exercise for this patient group, wider health system challenges etc? Some more discussion of these factors and some potential strategies/recommendations to improve the situation and patient outcome is needed. It would also be great to see some of these recommendations embedded in a relevant theory of behaviour change etc.

While the authors have conducted a study that has some relevance to vestibular rehabilitation, particularly in Saudi Arabia and similar countries, the reviewers and I share many reservations about the current quality of the submitted manuscript that will require substantial revisions prior to this being more seriously considered for publication in PeerJ. I therefore suggest you pay particular attention to the last two reviewers' comments in your resubmission.

[# PeerJ Staff Note: Please ensure that all review and editorial comments are addressed in a response letter and any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate. #]